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had patients of our own. Staffing was also a challenge as we were relying on hospitals to release staff when they were themselves under pressure but we had staff returning from retirement, from the private sector as well as NHS to help.
Given the complexity of the facility it was critical we supported our staff and Jo Cook and Di Robertson-Bell did an amazing job ensuring the staff had comfortable rest areas and that all our donations were shared out equally to all. We provided pastoral and mental health support on site. Jane Davis enlisted the help of the First Aid Nursing Yeomanry (FANY) to help us manage and communicate with our relatives. This was to cause much amusement when I announced at a meeting that as my Chief of Staff was now ill, I now had got my own FANY! The role of my FANY was to follow me everywhere and document all decisions I made, things I agreed to do or questions I needed to answer, a critical role and they (three FANYs took shifts) also nagged me to ensure I ate regularly and kept hydrated. Our virtual ‘Royal opening’ was on Friday 3 April and the first patient arrived on 7 April.
Staffing remained a challenge but was improving as our new members came on line, we had an initial ratio 1:6 critical care nurse to patient supported by two RNs and three Clinical Support Workers so one person for each patient. This then moved in line with other London hospitals at a
1:4 radio. Our bedside teams were supported by specialist teams of staff for line insertion, proning patients, physiotherapists, clinical scientists and medical staff. Shift handover was staggered to facilitate putting on PPE. We never ran out of PPE but it was a daily challenge but was supported by an amazing team of procurement staff. PPE was purchased and distributed centrally across London to ensure sites did not run out. We did trial washing of gowns in case we did have an issue but did not have to resort to their use. We also had Team Rubicon onsite putting together visors for our use, producing about 1000 a day so we started to redistribute these across London via the procurement hub.
Pharmacy was innovative preparing many antibiotics by teams outside in the clean area so staff did not have to prepare in the ward. They created our own Nightingale Drug chart. Clinically our biggest challenge was that the types of ventilators we had on site were mainly anaesthetic machines and not good for weaning patients. The environment was difficult as there were no windows or natural light so when a patient was extubated we needed to return them to their home hospital as soon as they were stable to transfer.
Daily we had a “Forum” where issues were discussed and changes agreed; this rapid decision and change ensured we fixed things very quickly.
Transfer of patients was complex due to patient instability, distance and
transit team availability. There was celebration when our first extubated patient was transferred back to his referring hospital; many of the staff cried when he left. He went home a week later.
Then it was over! London Critical Care Capacity was coping so our patients were transferred back with the last patient leaving on 6 May. As a part of returning staff we arranged the SJA team to screen all the staff leaving Nightingale and returning to their families.
So how did we do? We had 54 patients through the facility, at the peak we were operating 33 critical care beds. We sadly lost 20 patients but in most cases we were able to facilitate an end of life visit for the key relative.
So, what next? We are on ‘readiness’ until March 2021 should we be needed to support a second wave; let’s hope we are not.
Major (Retd) Deirdre Barr Director of Operations NHS Nightingale London
The Gazette QARANC Association 31
Covid-19 Managing Staff Mental Health at NHS Nightingale London
If any of you have been to the Excel Centreitisessentiallyaonekmlong conference centre with a spine down the middle with cafés which was now our command and logistic hub. Either side are two huge conference spaces which would each hold 2000 beds. The pace and scale was unprecedented in a way we’d never seen before, but the Excel was in many ways very suitable and really went beyond the functional characteristics of the sheer size of building.
NHS Nightingale was to support London and save as many lives as possible, and to do this as safely and
compassionately as we could given the circumstances, and the huge challenges this bought. Colonel Ash Boreham was the military lead and the QARANC personnel on the project were myself, Major Maggie Hodge (ICU advisor) Captain Jones and Major Eamonn Sullivan (Chief Nurse) also both Reservists.
We were going to have to ask staff to work in an environment that was alien and high risk, so it was essential that we built safety and support into all the things we did. Finally and perhaps more importantly, was maintaining humanity and personalisation.